A surgeon on the other side of the operation

Today started like any other day. I woke up, got ready, drove into work. I dropped my bag in my office, changed into scrubs, and wandered down to pre-op. After a few minutes of small talk with the staff, I found the patient I was looking for. He was awaiting a major operation. I spoke with him and his fiancé́ and laughed. They shared a few tears.

As I often do, I walked with the team as the patient rolled from pre-op to the OR. I helped transfer him. Anesthesia set up, leads were placed, oxygen administered. It was time for this patient to go to sleep. I held his hand, because (in my mind at least) in a cold room of strangers wearing masks, it’s nice to have a friend – to have some semblance of comfort. I do this frequently. Generally, the sicker the patient, the more likely I am to do it. I find it calms them, and me as well. None of this seems out of the ordinary to any surgeon on any given day in any given hospital. This is where things change.

The anesthesiologist pushed the propofol. I watched the milky white fluid trickle down the tubing into the patient’s forearm. His grip loosened on mine as he drifted off to sleep. I said, “I love you, Dad,” and stepped away and out of the room as they intubated.

You see, I was not the operating surgeon that day. This patient, this stoic man, was my father. The rock in my life. The man who raised my brother and me after our mother died. Moments before this, the strongest man I have ever known, sat calmly in pre-op. Everyone bustled around getting EKGs, starting IVs, preparing him for a major operation. He was quiet. He was scared. Not everyone could see it, but I could.

He fell asleep peacefully and without incident, unaware that something else was going on in my mind. Something that I have never before experienced in the OR – never as a resident or fellow and even now, fresh into my career as a new attending. Fear. Pure, unfiltered, heart-pounding fear. This – however small the chance – could be the last time I speak to my father.

I trained in Detroit for residency, followed by fellowship in Atlanta in trauma surgery and surgical critical care. I have spent more hours in trauma centers, ORs and ICUs in the past eight years than I have in my own home. My brief career has been punctuated by some of the worst trauma and sickest patients you can imagine. Some of them we saved. Some of them we didn’t. But I was never afraid like I was at this moment. I knew as a trainee, I had back-up if I needed it. I also know my skill set, and I know when to ask for help. Some may call it arrogance. I prefer to think of it as a reflection of the amazing surgeons that trained me.

This feeling of fear was so foreign to me. I knew that he was in great hands – the best that I could find. A phenomenal team was taking the greatest care of my dad. As I write this, his veins are being harvested, his chest cracked open, and five lesions bypassed on his heart. At some point this morning, my father’s heart will stop – supported by the perfusion machine. After the surgeon finishes, they will restart his heart. All of this is routine to them, like restarting his heart is like pulling the cord to start a lawnmower or jumping a car.

I began thinking about the families of my patients. What it’s like to be on the other side of that OR door. I have the luxury (or curse) of knowing the intricacies of this operation. I have assisted on it myself and cared for these patients post-op. Not everyone has that. Fear of the unknown can be the worst fear of all. Sure, to me, it’s just a straightforward colon resection or lysing adhesions to relieve a bowel obstruction. Even something as seemingly terrifying as a gunshot to the abdomen can be straightforward. But to the family in the waiting room, the patient’s child on the phone, or the spouse driving through the night to get to the bedside, “straightforward” or “routine” are words that have no meaning. Someone they love is having surgery. That fear of the unknown, fear they may not speak to their loved one again, it can be crippling. We, as surgeons, have an obligation to help put them at ease. We have a duty to quell that fear with reassurance that, although no promises can be made, we will do everything that we can to ensure the best outcome.

I was confident in the abilities of my father’s surgeon. He’s done (literally) thousands of cardiac surgeries. I also know this: Shit happens. To all of us. To any of us. Show me a surgeon that has zero complications, and you’re showing me a surgeon that hasn’t done enough operations. Preparing for my dad’s surgery has had me reevaluate my approach to patients. Being on the outside, looking in is terrifying. As clinicians, we should take a moment to remember that the person we are talking to may not have the privilege of the “known” that we have. Not to say that we are more intelligent than anyone else, but we have been trained for many years to know the human body, how it works, and why it does things. We need to be cognizant of what we say and how we say it.

Surgeons have a reputation for being cocky, arrogant, and dismissive. This is probably, to a point, a deserved reputation. We have to be confident. Would you let someone cut you open who didn’t seem like they were knowledgeable of what they were doing and confident in their ability to do it? I wouldn’t. But confidence doesn’t have to be condescending. I do my best to explain an operation/plan of care to patients and their families, so they feel comfortable with what we are going to do for them.

I implore physicians reading this, the next time you’re bothered by a patient asking the same questions, or frustrated to explain things a third or fourth time to family, remember this: not everyone is as lucky as you, to have an inherent understanding of and training in the complexities of the human body and medicine. Take a breath. Take a minute. Put yourself in their shoes and talk to them.

Remember, the view from the other side is scary. Be compassionate. Be kind. Be honest.

Andrew Isaacson is a general surgeon.

Image credit: Shutterstock.com

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